Enterotomy closure after minimally invasive distal gastrectomy with intracorporeal anastomosis: a multicentric study.

Introduction: Despite progressive improvements in technical skills and instruments have facilitate surgeons to perform intracorporeal gastro-jejunal and jejuno-jejunal anastomoses, one of the big challenging task is handsewn knot tying. We analysed the better way to fashion an handsewn intracorporeal enterotomy closure after a stapled anastomosis.Methods: All 579 consecutive patients from January 2009 to December 2019 who underwent minimally invasive partial gastrectomy for gastric cancer at thirteen high-volume institutions were retrospectively analysed. Different ways to fashion intracorporeal anastomoses were investigated: robotic vs. laparoscopic approach; laparoscopic HD vs. 3D vs. 4K technology; single layer vs. double layer enterotomies. Additionally, double layer enterotomies were analysed layer by layer, comparing running vs. interrupted suture; presence vs. absence of deep corner suture and type of suture thread (barbed, braided, non-braided suture).Results: Significant lower rates of bleeding (p = 0,011) and leakage (p = 0,048) from gastro-jejunal anastomosis were recorded in the double-layer group. Comparing barbed to braided and non-braided suture threads, the first was significantly associated to reduced intraluminal bleeding and leakage rates both in the first (p = 0,042 and p = 0,010) and second layer (p = 0,002 and p = 0,029). Conclusions: Our study found that double-layer sutures using barbed suture thread both in first and second layer to fashion enterotomy closure results in lower intraluminal bleeding and anastomotic leak rates.

Automated summary

This study found that using double-layer sutures with barbed suture thread can reduce the occurrence of intraluminal bleeding and anastomotic leaks in gastro-jejunal anastomosis.